CAJ | 학술논문

目的通过比较3种呼吸状态下三维适形放疗(3DCRT)、传统调强放疗(IMRT)、旋转调强放疗(瓦里安公司的为RapidArc,RA)计划,探讨主动呼吸控制(ABC)辅助RA放疗原发性肝癌(HCC)的可行性.方法选取12例HCC患者,依次完成ABC辅助下平静吸气末屏气(EIH)、平静呼气末屏气(EEH)、自由呼吸(FB)下CT模拟定位.对各呼吸状态下计划靶体积制定3DCRT、IMRT、RA(3个135°弧)计划,比较3种计划间、RA计划不同呼吸状态间的剂量学差异.结果 12例患者FB计划靶体积均大于EEH、EIH( 160.8、89.5、83.1 cm3,F=6.63,P=0.004).RA计划的适形指数和均匀性指数优于IMRT、3DCRT (0.92、0.90、0.77,F=72.55,P=0.000;0.90、0.89、0.84,F=125.49,P=0.000).3DCRT计划中正常肝V20、V30、V40高于IMRT、RA (24％、20％、19％,F=3.56,P=0.032;13％、10％、10％,F=5.74,P =0.004;8％、5％、6％,F=3.72,P=0.027). FB RA计划的正常肝脏平均受量、V10、V20、V30、V40均高于EEH和EIH (13.46、10.25、9.48Gy,F=3.63,P=0.038;46％、35％、32％,F =2.96,P=0.066;24％、16％、16％,F=3.69,P=0.036;13％、8％、8％,F=4.28,P =0.022；8％、5％、5％,F=2.39,P=0.108).EEH下RA的十二指肠5 cm3体积所受剂量低于FB与EIH(8.78、19.35 Gy与11.67 Gy,F=1.56,P=0.224).3DCRT、IMRT、RA机器跳数平均为254.06、626.33、550.28 MU (F=147.35,P=0.000),治疗时间平均为135、540、130s (F =62.83,P=0.000).结论 ABC辅助下3个135°弧的RapidArc技术可在保证靶区准确基础上用较少治疗时间及机器跳数完成适形指数和均匀性优于IMRT计划的剂量传输,更好保护正常肝脏.
목적 통과비교3충호흡상태하삼유괄형방료(3DCRT)、전통조강방료(IMRT)、선전조강방료(와리안공사적위RapidArc,RA)계화,탐토주동호흡공제(ABC)보조RA방료원발성간암(HCC)적가행성.방법 선취12례HCC환자,의차완성ABC보조하평정흡기말병기(EIH)、평정호기말병기(EEH)、자유호흡(FB)하CT모의정위.대각호흡상태하계화파체적제정3DCRT、IMRT、RA(3개135°호)계화,비교3충계화간、RA계화불동호흡상태간적제량학차이.결과 12례환자FB계화파체적균대우EEH、EIH( 160.8、89.5、83.1 cm3,F=6.63,P=0.004).RA계화적괄형지수화균균성지수우우IMRT、3DCRT (0.92、0.90、0.77,F=72.55,P=0.000;0.90、0.89、0.84,F=125.49,P=0.000).3DCRT계화중정상간V20、V30、V40고우IMRT、RA (24％、20％、19％,F=3.56,P=0.032;13％、10％、10％,F=5.74,P =0.004;8％、5％、6％,F=3.72,P=0.027). FB RA계화적정상간장평균수량、V10、V20、V30、V40균고우EEH화EIH (13.46、10.25、9.48Gy,F=3.63,P=0.038;46％、35％、32％,F =2.96,P=0.066;24％、16％、16％,F=3.69,P=0.036;13％、8％、8％,F=4.28,P =0.022；8％、5％、5％,F=2.39,P=0.108).EEH하RA적십이지장5 cm3체적소수제량저우FB여EIH(8.78、19.35 Gy여11.67 Gy,F=1.56,P=0.224).3DCRT、IMRT、RA궤기도수평균위254.06、626.33、550.28 MU (F=147.35,P=0.000),치료시간평균위135、540、130s (F =62.83,P=0.000).결론 ABC보조하3개135°호적RapidArc기술가재보증파구준학기출상용교소치료시간급궤기도수완성괄형지수화균균성우우IMRT계화적제량전수,경호보호정상간장.
Objective To study the feasibility of RapidArc (RA) associated with active breath coordinator (ABC) for hepatocelluar carcinoma (HCC) radiotherapy comparing of three-dimensional conformal radiotherapy (3DCRT),intensity modulated radiotherapy (IMRT),RA treatment plans in different breath status.Methods 12 HCC cases were selected.Three series CT scanning were completed in Free Breathing (FB),End Inspiration Hold (EIH) and End Expiration Hold (EEH) associated with ABC device.3DCRT,IMRT and RA (three 135° arcs) treatment plans were respectively designed on planning target volume (PTV) in different breath status.The dosimetric differences among 3 DCRT,IMRT and RA,among RA plans under different breath status were compared.Results The PTV in FB was larger than in EEHand EIH (160.8 cm3,89.5 cm3,83.1 cm3,F=6.63,P=0.004). The conformity index and homogeneity index of RA plans were better than IMRT and 3DCRT ( 0.92,0.90,0.77,F =72.55,P =0.000 ;0.90,0.89,0.84,F =125.49,P =0.000 ) ;the V20,V30,V40 of normal liver in 3DCRT were higher than IMRT and RA (24％,20％,19％,F=3.56,P =0.032;13％,10％,10％,F=5.74,P =0.004;8％,5％,6％,F =3.72,P =0.027).The normal liver mean dose,V10,V20,V30,V40 of RA plans in FB were higher than in EEH and EIH ( 13.46 Gy,10.25 Gy,9.48 Gy,F =3.627,P =0.038 ;46％,35％,32％,F =2.96,P=0.066;24％,16％,16％,F=3.69,P=0.036;13％,8％,8％,F=4.28,P=0.022;8％,5％,5％,F =2.39,P =0.108 ).The duodenum D5 cm3 of RA in EEH was lower than in FB and EIH (8.78 Gy,19.35 Gy and 11.67 Gy,F =1.56,P =0.224 ).The mean monitor units for 3 DCRT,IMRT,RA was 254.06 MU,626.33 MU and 550.28 MU ( F =147.35,P =0.000 ),while the mean treatment time was 135 s,540 s and 130 s respectively (F =62.83,P =0.000).Conclusions The RapidArc applying three 135°arcs with ABC in HCC radiotherapy can achieve better PTV coverage than IMRT with fewer monitor units,shorter treatment time and sparing more normal liver.